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General NPI Number Information
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NPI Number | 1629452123
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Entity Type | Organization
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Legal Business Name | PRESTIGE MEDICAL LLC
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 857 DOWNTOWNER BLVD STE G
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City | MOBILE
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State | AL
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Zip | 36609-5420
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Country | US
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Telephone | 251-341-7295
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Fax | 251-341-7690
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Provider Business Mailing Address
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Address Line | 103 S NAVY BLVD
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City | PENSACOLA
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State | FL
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Zip | 32507-3603
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Country | US
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Telephone | 850-361-1502
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Fax | 850-361-1503
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN NORRIS
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Credential |
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Telephone | 251-341-7295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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